The Causes of Hair Problems

The Causes of Hair Problems

The purpose of this chapter is to provide a complete and comprehensive survey of the biological causes of hair growth. Information of this kind is important to the student of electrology for three reasons. First, as the ”expert” in the field, you will often find that you must explain to clients the biological origin of hair and how it comes to be a problem. Secondly, you must be able to apply your knowledge to each new problem that comes through your door; the nature of the problem frequently determines the strategy for treatment, especially when it involves an alteration in the patron’s glandular balance. Finally, obvious signs of glandular imbalance should be recognizable to you, so that you can direct your client to specialists who are trained to handle the disorder. A knowledge of the principles and problems of hair biology and the glandular system is essential to competency in the field.

The Need For Appropriate Terminology

The majority of cases which confront the electrologist are completely normal instances of ”excessive” hair growth. In most cases, a patron’s hair problem will have emerged during puberty, pregnancy, or menopause, the three major physiological changes which can occur within a woman’s lifetime. These events do not invariably produce unwanted hair, of course, but the incidence of increased hair-growth following these events is so frequent- especially among women in their ”change of life”- that we cannot consider it ”abnormal.” Not any more than we could consider baldness abnormal in a man simply because it does not occur in every instance. It is a mistake, then, to call every person that walks into the electrologist’s office a ”patient” and to regard him or her as ”suffering” from hypertrichosis (a frequent mistake among some electrologists). Let us consider a definition of the term ”hypertrichosis” offered by a leading specialist, Lee McCarthy, M.D., in Diagnosis and Treatment of Diseases of the Hair: 

Hypertrichosis is the term used to denote excessive and abnormal growth of

hair, i.e., a growth of hair on any part of the body which is more than that usually seen in individuals of the same sex, age, and race as the person under

consideration. Hypertrichosis, then, is an abnormal amount of hair. It is usually due to abnormal conditions brought about by disease or injury. The above definition helps us appreciate that it is entirely inappropriate to apply the term ”hypertrichosis” to those new growths of unwanted hair on women going through their major physiological changes. Such people have superfluous hair, excess hair which is not abnormal for their age and sex but is simply undesirable socially. By thus distinguishing between ”hypertrichosis” and ”superfluous hair,” the electrologist will be employing terminology which is much more appropriate to the problems with which she must deal. Appropriate terminology is a key factor in successful relationships between the electrologist and the public. The student must realize at the outset that electrology is, in no sense of the word, a medical practice,

as certain electrologists would have us believe. Referring to patrons as ”patients” and talking about ”cures” is not only inaccurate (no disease is being treated); it is also detrimental to the business of electrology since only those patrons willing to consider themselves as ”afflicted” would ever subject themselves to treatment.

The problem which the electrologist treats is essentially a cosmetic one. Even in those cases where excessive growth has been caused by an unusual glandular imbalance, the intention of electrology is not to alleviate the illness but to restore the appearance of the individual. There are, of course, those instances where ingrown hairs must be removed for reasons of health, but they constitute a small percentage of the

business. The electrologist is primarily concerned with beauty, and her manner of dealing with the public should reflect this. Only when it becomes common knowledge that superfluous hair is perfectly normal for certain periods in a woman’s life will electrology become generally accepted and utilized.

What Stimulates New Hair Growth?

A brand-new growth of hair does not spring from the soil like a weed; it requires encouragement. The general causes of that encouragement will occupy the greater portion of this chapter. At present, however, we are interested in the specific conditions that must be present at the site of each potential hair to activate its growth.

Two local factors, either together or individually, have the capacity for directly initiating or accelerating the growth of hair: one is increased blood supply; the other is hormone stimulation. Let us consider their effects respectively: 

(1) Increased blood supply. If a vellus (or lanugo) hair is already growing from, say, the lobe of a sebaceous (oil) gland, an increase in the blood supply to the immediate area greatly enhances its growth. As if the hair were being ”fertilized” by the influx of this unaccustomed nourishment, it tends to grow deeper and coarser, becoming an ”accelerated” lanugo hair (i.e., one which is just beginning to acquire a bulb and take on pigmentation; it is not yet a ”terminal hair”). A plentiful supply of blood is necessary for the development of these deeper kinds of hair. Nevertheless, increasing the blood supply in an area where there are no hairs at all will not create new hairs. Blood supply merely nourishes existing hairs.

(2) Hormone stimulation. Certain hormones, on the other hand, seem to have the capacity for initiating the growth of new hairs where none existed previously. Of course an excess of hormones does not cause hairs to leap out of the flesh wherever it flows. If that were the case, we would have bristles sprouting from our tongues and our eyeballs. The fact is that hormones have no ”hair-growing” power in themselves. What they do is to stir to life certain cells near the sebaceous (oil) glands. These hair-germ cells need only be ”turned on” by the chemical action of the hormone. They then begin to multiply and divide, creating a lanugo hair structure which may continue to accelerate in growth. Thus, the action of certain hormones is capable of eventually bringing about a coarse, pigmented hair where no hair at all had existed.

It is obvious that the potentiality for hair growth will vary greatly from area to area on the human body. We can observe this in the young man in late adolescence, for instance. With unaccustomed quantities of male hormones coursing through capillaries throughout his skin he nevertheless fails to acquire hair from his nose to his toes. The growth tends to follow a normal pattern of appearance in the axillary and pubic regions, on the face and lastly on the chest. Such areas seem to have the highest potential, that is, the highest sensitivity to hormone stimulation.

Likewise in women, when a glandular imbalance occurs, these same areas are the first to show an increase in growth. Conversely, regions such as the center of the forehead, the palms of the hands and the soles of the feet never acquire hair, even among the most hirsute individuals. Degrees of sensitivity to hormone stimulation also vary from area to area, even from point to point within a given area on the body. Photographs of microscopic sections of any hairy area show that each follicle from which a hair is growing is surrounded by isolated sebaceous glands which have no hair growth of their own. 

Apparently, some factor makes one set of germ cells more active than its neighbors. This is further evidenced by the fact that every individual shows a large number of downy hairs in the bearded, axillary and pubic regions that never become transformed into terminal hairs, even in a forest of the coarser, darker hairs. Since the flow of hormones is presumedly available to all these germ cells in more or less equal quantities, we can only conclude that the uneven reaction is determined by unequal distribution of growth potential in the cells themselves. Thus, when certain hormones begin to flow through the tiny capillaries that feed the epidermal region, only those cells which are most sensitive to its stimulation begin to divide and multiply, forming a new hair structure.

What Conditions Cause Stimulation Of New Hairs?

It follows from what has been discussed above that any conditions which can cause an increase in blood supply to the skin or a general excess of certain hormones in the circulatory system may ultimately be the cause of either hypertrichosis or superfluous hair. These general conditions have, in the opinion of the authors, never been adequately classified from the unique standpoint of the electrologist. Medical books tend to categorize the causes of hypertrichosis into ”irritation” and ”non-irritation” (Bartels) or ”congenital” and ”acquired” (McCarthy) and the like. These terms strike your authors as curiously awkward classifications in view of the variety of conditions that make excessive growth of hair possible. Therefore, to clarify the matter for the electrologist, who must often explain her task to the public, a simple but comprehensive classification has been adopted.

There appears to be three general categories of causes for excess hair, which we shall label as (1) congenital (2) topical and (3) systemic:

The first term, ”congenital, has been retained from McCarthy to refer to normal racial and familial growth patterns as well as to those abnormal, conditions, which, although rare, are responsible for inherent hypertrichosis from birth. ”Topical” conditions are exactly what the word implies: local, limited to the skin or a particular portion of it. Lastly, all growths which are neither congenital nor topical are of ”systemic” origin: that is, they have been brought about by a change in the chemical structure of the endocrine system. This latter category is further divided into normal and abnormal systemic changes. All these categories need to be studied in depth. These categories are outlined below:

I CONGENITAL PATTERNS

(A) Normal Patterns

(B) Abnormal Patterns

II TOPICAL CAUSES

III SYSTEMIC CAUSES 

(A) Normal Patterns

(B) Abnormal Patterns

(C) Congenital Patterns

Everyone comes into the world with some pre-established pattern for hair growth, ”built-in,” as it were, as a part of his natural equipment. This pattern is inherited from parents whose own genetic structures combined to shape the new one. Hence, the way in which a person’s hair naturally tends to grow, either at birth or later in life, is called a ”congenital” pattern, because he is ”born with” a potentiality for that kind of growth; it does not come about as the result of environmental influences.

(A) NORMAL PATTERNS

Because we are all familiar with the ”normal” distribution of hair, there is little need to catalog its various locations here. But it is of general interest to note how growth patterns on various parts of the body have, through the principle of ”natural selection,” evolved into organs that help the body adapt to its environment. Most hair, it has been observed, serves a protective function. In some instances, hair also helps to retain body heat. Let us briefly examine some of the specific functions of hair at various locations:

(1) Eyelashes (cilia) prevent dust or dirt from entering the eye and

also help to shade the eye from excessive sunlight.

(2) Eyebrows (supercilia) also filter dust and dirt to a minor degree

and help to shade the eye from sunlight. Additionally, they form a protective cushion for the ridges of the eye socket.

(3) Nostril hair (vibrissae) screens incoming air, filtering out dust and large particles that might otherwise collect in the lungs.

(4) Scalp hair (capilli) serves as an adornment of the body. But such a ”function” is by no means an evolutionary one; man (or, more correctly, woman) has been the one who made hair an object of beauty. Nature has, on the other hand, placed hair on the head merely to pro- vide protection against concussion and to help retain body heat by shielding the head-from the rain, snow and cold weather.

(5) Body hair, by which term we include underarm hair (hirci), pubic hair (pubes) and others, acts generally as a protection against friction. It is for this reason that patches of excess hair will appear in many places where the epidermis is continuously irritated. It is presumed by some people that man at one time was covered with much more hair than he now has, and that his hair farmed a ”fur coat,” which kept him warm in winter. Whether or not this conjecture is true may possibly never be determined. If it is true, however, we must somehow account for the fact that people from the warm Mediterranean areas are more hirsute than cold-weather Scandinavians.

Significantly, no one undergoes an increase in hair growth when transported to a colder climate in the way that he would if his skin were to be irritated by friction, fire, or chemicals. In the light of this fact, it is difficult for us to conclude that body hair is intended for warmth. Protection from irritation seems to be its principal function. What we would call a ”normal” distribution of hair will vary from one ethnic group to another. As mentioned above, Nordic or Anglo- Saxon strains (Scandinavians, Germans, and British) are less hairy than the Mediterranean and Semitic peoples (Syrians, Hebrews, North Africans, Greeks, Italians and Spaniards). And, in general, Caucasians are hairier than people of African descent. Least hairy of all are people of Asian descent, and American Indians.

It is obvious that one’s concept of beauty depends a great deal on what he has become accustomed to seeing. The facial hair of Mediterranean women is not at all bothersome to their male counterparts. For example, among the Spanish and Italians a woman’s moustache is considered ”sexy.” In few places besides the United States are a woman’s hairy legs regarded unattractive. Thus, whether one’s hairiness is considered an adornment, or an ”eyesore” depends pretty much on geography. It is only in a mixed society, such as our own, that a normally hirsute person can become embarrassed or even ashamed of a natural condition that might have seemed attractive in the person’s place of origin. This is just another reason why the electrologist cannot consider herself a practitioner who treats abnormal conditions. Many of her clients will have hair patterns which are perfectly normal for them.

(B) ABNORMAL PATTERNS

Every once in a while, the electrologist will confront a case of congenital hypertrichosis. This condition afflicts the person who has had the misfortune of inheriting a propensity for unusually excessive hair growth. Congenital hypertrichosis may appear at birth, or it may emerge later in life. People thus afflicted are sometimes covered from head to toe with a heavy growth, lacking hair only in those areas that normally would have no hair at all, such as the palms of the hands, bottoms of feet or the forehead. Danforth has carefully studied cases and found no glandular imbalance to which the growth might be attributed. The excessive hair is simply that result of an unusual genetic structure. Fortunately, cases of congenital hypertrichosis are rare. Because of the extent and heaviness of the growth, its treatment requires many years.

(Il) Topical Causes

In response to any potential threat to the epidermis by rubbing, chafing, burning or other causes of irritation, nature has provided the body with an ”ingenious” means of defending itself. Sustained irritation almost always stimulates hairs in the immediate vicinity of the affected area to grow deeper and coarser, thereby creating a mat of hair that covers the skin and protects against further irritation. The mechanics of this process is not overly complicated. Wherever there is irritation, there is an increase in blood supply to the surface of the skin. When this increased blood supply reaches the follicles, any hairs growing from those follicles receive more nourishment than usual. They therefore tend to grow deeper and coarser. It can thus be seen that anything that will cause an increase in blood supply to the surface of the skin can become a topical cause of hair growth. 

Although moles and birthmarks are not sources of irritation as such, they do fall within the general definition of topical causes of hair insofar as their presence is the cause of an unusual development of capillaries near the surface of the skin. Moles and birthmarks are frequently a cause of excessive hair growth. It is not unusual to find clusters of thick bristles sprouting from moles or other surface blemishes in an area otherwise devoid of noticeable hair. This occurs as the result of the specialized blood supply system which nourishes the follicles located in the blemish itself. These follicles thereby become more productive than their neighbors. Moles and birthmarks pose a special problem to the electrologist. Although to your authors’ knowledge no case of cancer has ever been traced to treatment by an electrologist, there is a general prejudice against treating hairy moles with an electric needle by anyone other than a person trained in medicine. Insurance companies specifically exclude treatment of moles, warts or other such unusual skin defects from liability coverage, precisely because certain kinds of skin growths have been known to be malignant.

It has been shown how almost any form of physical irritation on the surface of the skin will produce an unusually luxuriant growth of hair to protect the skin. These topical causes include plaster, scratching (Hebra’s prurigo), and application of x-rays, ultra-violet lights, etc. Even sunburn, if it occurs frequently, will lead to unusual growth, as seen in the case of outdoor sportsmen or workers, whose oft-burned noses sometimes develop a growth of soft lanugo down after a few seasons in the sun. Everyone has a barely visible crop of lanugo hair on his nose, but it is only after his nose has been constantly irritated by something like a continuous series of second-degree burnings by the sun that the

growth is encouraged to grow to a visible length. The commonest experience of a topically-caused growth of hair occurs when an area has been bandaged or has been encased in a cast or a plaster for two or three months. Constant chafing has caused a protective covering to appear. Usually, the growth disappears shortly after the covering has been removed. Because of its short life, most topically- caused hair is of little clinical interest. Only such permanent conditions as hairy moles and birthmarks become the object of electrological treatment. Often, too, the area surrounding a scar will manifest an unusual

growth that must be treated. One topical consideration of great interest to the electrologist is the effect that tweezing has on hair growth. Many women attempt to remove unwanted hairs, especially those around the eyebrow or on the chin by plucking them out by the roots. Granted, when a woman tweezes out unwanted hair it does take longer to grow back than if, say, it has been shaved off at the skin level. But what this woman does not realize is the fact that repeated epilation eventually causes most hairs to regrow more quickly and to become darker, coarser and more firmly rooted. Only a fraction of all tweezed hairs is ever permanently eliminated. Thus, a woman who tweezes is simply letting herself in for greater hair problems than she had before she tweezed; rather than solving her problem, she is worsening it. 

As with other topical causes, increased blood supply is the cause of the accelerated growth of tweezed hair. Each time a hair is tweezed out of its follicle, a good portion of the bottom half of the follicle is tom out. The damage is not sufficient to prohibit future growth, but it is enough to cause the follicle to reconstruct itself a little sturdier with a better developed capillary system each time. The difference from one tweezed hair to the next may be imperceptible, but eventually what may have been a few annoying lanugo hairs will have become full- grown terminal hairs, bristling in defiance of their owner’s attempts to

evict them.

Impracticability is not the only reason for refraining from tweezing. It has been found that occasionally when a hair is plucked from a soft sensitive skin, the entire sheath of the follicle often comes out with it. The resulting cavity quickly becomes infected with the organisms, usually yellow staphylococci, which normally inhabit the follicular pore. Deep pustules that result leave a whitish scar or pit. Shaving, on the other hand, has been found to have no effect what- soever on hair growth. This fact has been demonstrated by several experiments on the subject. Trotter, for example, conducted a series of experiments to test the effect of shaving various parts of the body in adults of both sexes. By pairing off accurately symmetrical areas on each side of the test subject, Trotter was able to observe the results of shaving on one of the areas in relation to its ”twin,” which remained unshaven. She made measurements of both areas before and during the time of testing, which involved shaving the test area daily. After several months of this, she could detect no difference in amount, length, diameter or pigmentation of either the lanugo or the terminal hairs present on either side. A similar test at Duke University has produced the same negative results. Such evidence seems to support the hypothesis that only an irritation of an intense nature sustained over long periods of time is able to accelerate hair growth. Rubbing the skin once daily with a shaver is insufficient irritation to cause a marked change in the circulation pattern.

In the light of these facts about tweezing and shaving, we can evaluate such common feminine remedies for superfluous hair as waxes and depilatories. Waxing, for instance, can now be appreciated as a specialized tweezing method. The practice is to apply a heated wax to the surface of the skin, letting it cool and harden. When it is

pulled off it removes most of the hairs and their roots. Most beauty shops employ this method, often with misleading claims about the permanence of the removal. As with tweezing, continued treatments will lead to darker, coarser hairs. Furthermore, the method must be repeated every three or four weeks to keep the growth out of sight. Lastly there is always the possibility of the infection that may result from tweezing. As was suggested earlier, any form of tweezing-including waxing- will meet with some success. On certain people and on certain areas, particularly the eyebrows, some lanugo and accelerated lanugo hair will ”give up” after being uprooted many times. These instances serve as the ”shining examples” upon which beauticians base their claims for waxing.

Many cases where waxing has ”worked” are questionable. Waxing ”appears” to be most successful when used on the limbs of women after their late forties or early fifties. This is usually the result of glandular changes, which would ordinarily result in a diminishing of hair regard- less of hair removal practices. Waxing simply accelerates the natural hair loss. The most disastrous consequences waxing can produce occur on the face. There are some fine lanugo and ”accelerated” lanugo hairs on the face that will respond favorably to waxing. But most other hairs in the same area will, on the contrary, be stimulated to greater depth and coarseness. Thus, face waxing, usually, will lead to a superfluous hair problem that never existed previously-a face full of scattered, heavy bristles. 

Depilatories, on the other hand, do not involve any plucking of the hair. Various preparations on the market today come in the form of a cream or paste which is applied to the skin. After it has been left on the skin for several minutes, the depilatory is washed off, and the hair comes off with it. Since this process is really a chemical shaving- off the hairs at the skin level, the use of depilatories does not, like tweezing, encourage an accelerated growth in the treated area. Depilatories, therefore, have a decided advantage over waxes in this regard. Among the disadvantages of depilatories is the nuisance factor; treatments must be repeated only a little less often than shaving. Furthermore, it is not uncommon to see a dry or ”weeping” type of dermatitis following the use of depilatory pastes or creams. This condition lasts from twelve to twenty-four hours after application. Thus, the only advantage of depilatories over ordinary shaving is the ”closeness” of the shave. This advantage can hardly compensate for the messiness and possible irritation involved in the use of depilatories. One last implication of topically caused hair growth must be mentioned before leaving the category of topical causes. The question concerns electrology. Not infrequently, it seems, ”seasoned” electrologists are moved to ask whether the electrologist’s needle itself might be the stimulus of new growths of hair. After all, they reason, is not electrology a form of surface irritation? These electrologists have in mind the fact that on occasion one finds that a woman’s hair growth will accelerate after treatment has begun. Could the treatment have caused the acceleration?

To answer this question, we must reexamine the basic principles involved in accelerated hair growth. Almost every instance of accelerated growth, we have found, has been the result of a sustained source of irritation. Perhaps the only exception to this is the case of scars. A severe scar is often surrounded by an unusual growth of hair. But to put this exception in its proper perspective we must recall that small cuts or burns are never accompanied by any such growths. Only large lesions effect permanent changes in circulation. Conclusion: nothing of such minor intensity or of so short duration as the electrical action of the electrologist’s needle could alter the permanent cutaneous blood supply sufficiently to cause a marked increase in hair growth. There is no experimental evidence that implies that it could be such a cause. Since the incidence of increased growth fallowing treatment is rare, it is quite probable that the increase is due in those unusual instances to a coincidental change in the hormonal balance. As a woman enters her ”change of life,” for example, the alteration of her body chemistry will cause the lanugo hair on her face and certain parts of her body to accelerate. Alarmed, she may immediately visit an electrologist. What neither she nor the electrologist suspects is that the change has only begun. As the hormonal balance continues to alter, the unwary electrologist finds the hairs growing in faster than she can take them out. To both patron and electrologist it may seem that the treatment is doing more harm than good.

(III) Systemic Causes

To appreciate how body chemistry can affect hair growth, one must have a rudimentary understanding of the endocrine system. Hormones, which are excreted by the endocrine glands, control the growth and development of every organ of the body, including the hair. The interrelationships of these glands are so complex, however, that scientists have only begun to understand the total mechanics of the endocrine system. Therefore, the brief outline of the function of the endocrine glands offered below is not to be construed as a detailed analysis. It is no more than a ”primer course” for electrologists.

THE ENDOCRINE SYSTEM

The endocrine system is not an isolated machine carrying out a distinctly specialized function in the same sense that, for example, the heart and lungs do. The chemicals which these organs pour into the circulatory system are so closely integrated with the life processes of the body that there is probably not a single activity that is not affected by them. Growth, aging, sex, metabolism, and nutrition are among the principles of life over which these glands hold complete control. In close cooperation with the nervous system and the body fluids, they correlate and coordinate the activities of the body as a whole. 

Endocrine glands are usually called glands of internal secretion because of the way they exude their chemical products directly into the blood stream. Each gland is composed of millions of cells, each of which is a miniature hormone factory. In most cases the hormone passes from these cells directly into circulation. Some glands like the thyroid can store up their products in special sacs, releasing them into the blood stream when called upon to do so.

Once these hormones enter the blood stream they travel indiscriminately throughout the body coursing through every artery, vein, and capillary in the circulatory system. Some hormones such as thyroid hormone appear to act on almost every cell of the body. Others, however, limit their activity to certain type of tissue. These are referred to as the ”target” organs of the hormone in question. We have already discussed briefly how the hair follicle can be a ”target” organ for those hormones which encourage its growth. In a similar manner thousands of other organs are affected by a vast arsenal of hormones. The results of this multiplicity of activities can be classified into three groups: (1) morphogenesis, which includes growth, metamorphosis, and sexual development; (2) integration of all the autonomic (automatic) processes of the body and instinctual patterns of behavior; and (3) maintenance of the internal environment by regulating disposition of

food stuffs, electrolytes, and water within the body. 

The way in which hormones produce their effects is not clearly understood. They seem to act as a catalyst, accelerating processes which would scarcely proceed without them. It is argued by some endocrinologists, however, that hormones act indirectly by increasing the local concentration of certain enzymes which are themselves the direct cause of change. In either case, hormones activate the rate of specific processes without contributing significant amounts of energy to the tissues involved.

A significant aspect of the endocrine system is the fact that one hormone may assist another, while, at the same time being antagonistic to a third. In such a way, the secretions of one gland can control the effectiveness of secretions of others. This interaction of hormones is one means of achieving an overall balance in body functions. 

Another aspect of achieving a balance of functions is the way in which hormones control the activity of the endocrine glands themselves. When a specific gland is a target organ for a hormone secreted by another, its own production of hormones is enhanced or inhibited, according to the nature of the hormone effecting it. The anterior portion of the pituitary gland (the adenohypophysis) is generally regarded as the ”director” or ”master gland” of the endocrine system because of the controlling role its secretions play in the activity of other organs. But the pituitary gland is in turn affected by certain hormones produced by the very glands it controls. It is also regulated indirectly by the nervous system. With so many little mechanisms to go wrong, it is surprising that glandular imbalances occur as infrequently as they do. 

Figure 1 shows the anatomical location of the glands of the endocrine system. Since the scientist cannot simply open the body up and watch the glands in action, he has only been able to learn about the role of each gland by indirect means, such as the removal of certain glands, or the injection of glandular abstracts, or the study of diseases caused by malfunctioning glands. The following is a brief outline of scientist’s findings about the functions of the endocrine system:

The pituitary gland, which looks like a cherry dangling from the base of the brain, is made up of three lobes (parts). The posterior lobe releases two hormones, one which is influential in certain processes connected with childbirth and another which helps prevent loss of water from the kidneys. The intermediate lobe puts out a hormone which brings about a deepening of skin pigment.

We have noted that the anterior lobe of the pituitary is called the ”master gland” because of the way some of its hormones control the activities of other endocrine glands. In addition, another of its hormones regulates the growth of the entire body. When the anterior lobe ceases to function, growth and development of the body are severely impaired. 

Among the various regulating hormones of the anterior lobe are the gonadotrophins, which regulate the development and function of the gonads (sex glands), thyrotropin, which regulates the activity of the thyroid gland, and adrenocorticotropic hormone (ACTH) which controls the functioning of the adrenal cortex. Since the adrenal cortex and the sex glands are both sources of hair-stimulating hormones, the ”master” gland has an indirect effect on hair growth through its control over these other glands. An excess of pituitary hormones has been known to result in superfluous hair.

The thyroid gland consists of two lobes which are located on either side of the windpipe in the neck. The principal function of thyroid hormone is to regulate metabolism, but it also indirectly effects growth and nutrition. Because of the complex triangular interrelationship between the thyroid, the anterior pituitary, and the gonads, an abnormal

amount of thyroid hormone may ultimately cause the production of excess hair-stimulating hormones. But specialists are not in agreement on this point, and it remains for the present only in the realm of

possibility.

The parathyroid glands are four tiny bodies located on the thyroid gland. They regulate the way the body utilizes calcium and phosphorus. Parathyroid activity seems to be unrelated to the function of other endocrine glands, and it is therefore doubtful that it would have much influence on the growth of hair.  

The thymus gland, located in the chest cavity behind the breastbone,

is still a mystery to physiologists. Neither its function nor the nature of its secretions has been determined.

The pancreas is not itself an endocrine gland, but it contains groups of cells called the islands of Langerhanswhich produce two hormones, glucagon, and insulin. Lack of insulin, which helps blood sugar gain entrance to the body cells to provide energy, leads to a condition called diabetes milletus, commonly referred to simply as diabetes. The diabetic poses special treatment problems to the electrologist.

The adrenal glands, also called supra-renals, are situated one above

each kidney. There are two parts to an adrenal gland: the medulla, or

core, and the cortex, or outer portion. The medulla produces adrenalin and epinephrine, which are released into the circulation system the moment a person becomes frightened, angry, or very excited. These hormones are instrumental in preparing the body for fight or flight, by enhancing all those activities which will give it energy and strength.

The adrenal cortex produces hormones called steroids, which are of such vital importance that one would not be able to survive without them. Although there are more than thirty known steroids, they can be grouped as follows:

1. Sex hormones:

(a) androgens (male)

(b) estrogens (female)

(c) progesterone (female)

2. Corticosteroids

(a) glucocorticoids

(b) mineralocorticoids

Sex hormones decide the individual’s sexual development. The adrenal cortex produces a small supply of both male hormones (androgens) and female hormones (estrogens and progesterone). Because of the adrenal cortex, everyone carries a combination of both sexes in him, so far as his hormonal potential is concerned. It is the predominance one set of sex hormones over the other which ultimately determines an individual’s secondary sex characteristics. That predominance is established by the activity of the gonads, which are the next glands to be discussed. The important thing to keep in mind about the adrenal glands is that for both sexes they are a source of androgens, which are capable of stimulating face and body hair. The adrenal androgens play an important role in the normal appearance of body hair during puberty. 

The other main group of hormones put out by the adrenal cortex, the corticosteroids, includes alderostone, which regulates the amount of

sodium and potassium used by the body. Others are cortisone and hydrocortisone which are needed by the body to adjust to the stresses of living as well as for other functions. In the section on abnormal systemic conditions, we shall see how a deficiency in cortisone production can cause the pituitary to stimulate an overproduction of adrenal androgens, thereby creating a condition of hypertrichosis.

The gonads contain the cells needed for reproduction. They also produce certain steroids similar to those produced by the adrenal cortex. The male testes are known to produce the all-important androgens. However, some estrogens have also been found in this gland.

The most potent androgen produced by the testes is called testosterone. Testosterone is the cause of physical changes during puberty such as the growth of the beard, the deepening of the voice and the enlarging of the genitalia. These are regarded as secondary sex characteristics because they are after the primary sexual organs with which males are born. Loss or malfunction of the testes prior to puberty will leave the individual without masculine characteristics. In the seventeenth century the Italians made a practice of castrating their more promising choir boys so that the latter could retain their high soprano voices as adults.

The ovaries, which are the female counterparts of the male testes, direct the reproductive life of woman. First, they produce the female sex cell, the ovum. Secondly, they secrete a group of hormones called estrogens, which are instrumental in the fertilization of the ovum by male sperm, and which are also responsible for the emergence of secondary female characteristics. Thirdly, the ovaries manufacture other hormones such as progesterone and relaxin which are also of importance for reproductive processes.

Like the male sex gland, the ovary has been found at times to be capable of producing hormones like those put out by the glands of the opposite sex. There is some speculation that because the male and female glands originate from the same undifferentiated mass of cells in the fetus, the eventual sex differentiation of these glands is not always complete. Thus, a small amount of androgen-producing tissue sometimes persists in the ovary. Whether or not this conjecture is true, it is nevertheless widely known that certain ovarian tumors can lead to an unusual output of testosterone-like androgens.

It can now be seen that many glands of the endocrine system can affect the stimulation of body and face hair, either indirectly, as in the case of the pituitary gland or possibly the thyroid, or directly, as in the case of the adrenals or the gonads. Only the androgens are known to stimulate hair-growth on the face or body directly. Thus, any spontaneous appearance of hair on face or body are ultimately traceable to a

systemic imbalance involving an increase in the production of androgens. 

It is significant to note here that estrogens do, in an indirect way, effect the level of hair-stimulating androgens produced by the adrenal cortex in women. But this effect occurs only systemically and only through ultimate hormonal control of the activity of the adrenal cortex. As for any direct effect, medical research indicates that the topical administration of estrogen does not in any way reduce the local hair-stimulating effects of androgens; the one hormone cannot direct!)’ reduce the effects of the other hormone*. [Footnote] These findings demonstrate that methods of ”hair removal” which rely on topical estrogen applications are completely worthless. No cosmetologist has legal access to estrogens of sufficient strength to induce an adequate systemic change. Cosmetologists who advertise a treatment which combines waxing with estrogen applications are, in effect, combining two ineffectual methods. The hormones are too weak to have any effect, and the tweezing, as mentioned earlier, tends to strengthen and coarsen the hair, rather than diminish it.

(A) NORMAL SYSTEMIC CHANGES

To understand the way in which glandular alterations can bring about normal growths of hair during such periods as puberty, pregnancy and menopause, we might envision the human body in terms of a master blueprint on which certain special areas have been designated as the site of future hair growth. These ”target” areas are the same for men and women. The one factor which saves a woman from the male’s typical hairiness is a difference in endocrine structure. Androgens are the only hormones capable of stimulating target follicles to produce hairs, and a woman’s system usually produces smaller quantities of these than does a man. Nevertheless, during puberty, pregnancy, or menopause these quantities are apt to increase, inevitably resulting in increased hairiness.

The following are the terms applied to the hair on each section of the body:

Barba-the face. 

Capilli-the head. 

Cilia-the eyelashes.

Hirci-the armpit.

Pubes-pubic region. 

Supercilia- the eyebrows. 

Tragi-the ears.

Vibrissae- the nostrils.

The pattern of development for any given individual will vary according to the hormone sensitivity of each area, a sensitivity which is strictly hereditary. Figure 1A shows those areas which are normally sensitive to an excess of androgens. For everyone the pattern will be slightly different, so that we can never predict where an increase in

androgens are likely to effect hair growth. Some women develop body hair without any effect to the face. Others may develop lip or chin growths without changes elsewhere. But in all cases of spontaneous growth the change must be triggered by an increase in androgens.

FIGURE 1A:  “Blueprint” of normal ”target” area for androgen stimulated hair growth. (Male and female.)

1) Puberty

One of the first events in that period of life known as puberty is the secretion of certain gonadotrophic hormones by the anterior pituitary (”master”) gland. The target organs of these gonadotrophins are the gonads, i.e., either the ovaries in woman or the testes in man. In addition, the adrenal cortex is stimulated to action at around the same time.

Both these glands, the adrenal cortex and the gonads, are thus encouraged to excrete large quantities of steroid hormones into the circulatory system. In the male, the influence of adrenal hormones on bodily changes is largely overshadowed by the action of the testicular hormones. In the female, we find the female estrogens produced by the ovaries working in conjunction with the male androgens from the adrenal cortex to create secondary sex characteristics.

Of special interest to the electrologist are the specific changes in hair growth resulting from increased amounts of androgen during puberty. In women the increase in adrenocortical androgens is responsible for the appearance of pubic and axillary hair. The appearance of hair in other regions apparently depend on both the woman’s hereditary sensitivity to androgens and the number of androgens produced.

In men the adrenocortical androgens control the appearance of pubic and axillary hair, but testosterone, the principal hormone of the testes, is responsible for all other hair patterns. For example, even though pubic hair is generally stimulated by adrenocortical androgens, the characteristic linear extension of the male pubic hair towards the umbilicus is due to the action of the testosterone. Testosterone also influences the growth of the beard, converting the soft down of the boy into the man’s wiry bristles. Hair on the trunk and limbs is another result of testosterone influence. One perhaps unfortunate effect of testosterone is the recession of the male hairline, generally beginning in the third decade in cases where there is an inherited propensity to baldness. 

The usual hair problems which accompany abnormal puberty involve accelerated lanugo hairs which may appear on the face or on portions of the body which are normal target areas. These long hairs may in many young girls reflect a simple temporary imbalance, the coordination of the adrenals and the ovaries not necessarily having been established immediately. It is not necessary to treat such hairs unless they become terminal hairs, since it is probable that they will subside appearance is there any necessity for treating adolescents. Tweezing should be discouraged for it will eventually lead to those scattered coarse hairs found in many older women.

2) Pregnancy

Pregnancy is a time of unusual endocrine activity during which time it is not unusual for an excess of androgens to be produced. Often a growth will appear on the upper lip, chin, and sides of the face of a woman in pregnancy. Seldom, however, do these become terminal hairs.

Not long after the woman has given birth the endocrine balance is restored, and the recalcitrant crop disappears. Treatment is therefore unnecessary.

3) Menopause

Menopause marks the end of a woman’s reproductive life and is a gradual yet radical change which takes place over a period of years, usually beginning at around 40 years of age. Menopause is a time of great stress for most women; and the emergence of a new crop of hair is hardly a comforting addition to the problems menopause often brings. The basic cause of this change is a decline in the secretion of estrogens by the ovaries. Unfortunately, excessive hair is a frequent accompaniment of menopause, owing to a failure of the ovaries to produce sufficient hormone. Since hormones produced by the ovaries have an inhibiting or restraining effect on the anterior pituitary, lack of estrogen means lack of proper control over this master gland, which then begins to pour out a flood of stimulating hormones. This results in a hyper- stimulation by pituitary hormones of the adrenal cortex which in turn produces, among other things, an excess of hair-producing androgens. Thus we often find women whose ovary activity is declining (usually after age thirty five) developing facial and body hair.

At the beginning of a woman’s change of life, she may acquire accelerated lanugo hairs and a few bristles. Often the chin hairs increase one by one over a period of years until pseudo-tufts of heavy dark hairs are farmed, especially on both sides of the chin.

The majority of the electrologist’s clients will be women in or beyond their ”change-of-life” period. It is to these women that the electrologist can be of greatest service since many of the hairs developed during this period are of a permanent nature. It is important to realize, however,

that in treating these clients the electrologist accomplishes nothing by removing infinitesimal lanugo hairs. Only a small percentage would ever become terminal hairs and treating them would only create a needless expense to the patron. The electrologist should concern herself with only those hairs which have already become accelerated lanugo or terminal hairs. If treatment is begun late in menopause or after the change-over is complete, one seldom finds any heavy new growths of terminal hair, just an occasional appearance of scattered bristles.

(B) ABNORMAL SYSTEMIC CHANGES

Sometimes an endocrine imbalance will result from unnatural circumstances. Often, this involves a pathological disorder which requires immediate treatment by a qualified physician or endocrinologist. The electrologist must be prepared to recognize these disorders in order to counsel prospective clients wisely. In such cases hypertrichosis must first be treated through correction of the underlying cause, i.e., the glandular imbalance itself. Then, once medical treatment has been started, the electrologist may deal directly with the hair problem.

The wisest advice an electrologist can give to a client suffering from an endocrine disorder is that he or she report to a specialist as quickly as possible. Do not attempt to diagnose the patron’s problem yourself. A thorough examination by a licensed qualified specialist is the only sure method of determining the true nature of a patron’s problem. As a matter of policy, you should refuse to treat any patron who manifests such pathological symptoms until the patron has visited a specialist and received permission to proceed with electrology treatment.

1) Pathological Changes

The outline of abnormal endocrine conditions offered below should be used merely as a guide for detecting pathological conditions. The term ”pathological” is intended here to indicate those disorders which involve some form of disease; they are not the result of surgery, medication or emotional circumstances, each of which causes will be discussed separately. Pathological endocrine disorders arise out of: ( 1) a glandular defect inherited from either parent, (2) an acquired disease infection, (3) a tumor or (4) a dietary deficiency. Listed below are several common pathological disorders which result in hypertrichosis.

Cushing’s Syndrome. A syndrome is a group of symptoms and signs, which, when considered together, characterize a disease or lesion. Cushing’s syndrome involves a collection of symptoms brought on by a prolonged excess of adrenocortical hormones, among which are included adrenocortical androgens. Hirsutism is one of its signs.

Cushing’s syndrome is characterized by rapidly developing obesity of the face, neck and trunk, whereas the arms and legs are unaffected. Subjects become round shouldered. Women cease to menstruate. Skin is dusky, acquires purplish lines, and bruises easily. Backache and abdominal pain are also very common.

There are many possible causes of Cushing’s syndrome: excessive cell development (hyperplasia) of the adrenal cortex, tumors of the cortex, certain tumors (adenoma) of the pituitary, or prolonged medication with doses of adrenocorticotropic hormone (ACTH), cortisone or hydrocortisone-in short, any kind of condition which will cause the adrenal cortex to produce excessive amounts of hormones, including androgens.

Adrenogenital Syndrome. This syndrome, which is somewhat rare, arises when the adrenal cortex becomes unable to utilize the chemical materials needed for manufacturing cortisones. Instead, it transforms them into androgens. Since the pituitary puts out adrenal-stimulating hormones in proportion to the amount of cortisone circulating in the system, the lack of cortisone causes it to encourage the cortex to work even harder. But all the cortexes can produce is androgens, which it secretes in even larger quantities.

When this condition exists in the fetus it produces a ”false hermaphroditism” in girls, wherein they retain their ovaries, but the external genitalia tend toward masculine development. In childhood boys become precociously developed sexually, acquiring all the secondary characteristics associated with puberty. Little girls may develop a beard and moustache, a deep voice, and an athletic muscular development, as well as other male secondary sex characteristics. This condition, as it appears in childhood or in its less extreme form in adulthood, is often referred to as adrenal virilism, a term which would apply equally well to the masculine traits emerging out of Cushing’s syndrome.

The causes of the adrenocortical syndrome usually involve an abnormality of the adrenal cortex, such as a tumor.

Archard-Thiers Syndrome. Diabetes of bearded women, as it is sometimes called, is a rare condition in which features of the adrenogenital and Cushing’s syndrome are combined. 

Stein-Leventhal Syndrome. This disease is characterized by lack of menstruation and/or abnormal uterine bleeding, frequent hirsutism, and occasional obesity and retarded breast development. The ovaries are found to contain multiple cysts, which are possibly the cause of the

disorder.

Acromegaly. Excessive pituitary hormones, when they are produced by the anterior pituitary gland early in life, lead to gigantism, which is a disease marked by the rapid growth of the body to extremely large proportions. If, however, the excess hormones do not begin to flow until the body has so matured that it is not capable of further symmetrical development, the abnormal growth occurs in the form of acromegaly. At that time only those portions of the body capable of responding to

the hormone continues to develop. 

Acromegaly is characterized by the coarsening of the features, due to

the continued growth of tissue. Hands, feet, and face show the greatest change. The enlargement gives rise to pressure symptoms in many areas. Defective vision and even blindness may result. Besides the effect on growth, many secondary changes in the function of other glands occur as the result of this disease of the master gland. Included among these changes is the production of androgens, which in many men and women results in extensive hypertrichosis, including heavy face and lip growth. 

The cause of acromegaly is usually a tumorous growth of the pituitary.

There are other endocrine conditions besides those listed above believed to be responsible for hypertrichosis. However, many of them are controversial. For example, both hypothyroidism and hyperthyroidism have been indicated at various times as the cause of hirsutism. But some specialists deny that this can be the case. The problem involved here, as in so many cases of glandular disorder, is the sheer complexity of the endocrine interrelationships. The thyroid problem may only be the result of some other problem, which itself is stimulating excess androgens. Much more research in endocrinology is needed to discover the full range of possible endocrine relationships capable of causing hypertrichosis.

2) Surgical Changes

The surgical removal of the sex glands (ovariectomy or oophorectomy) in women after puberty brings about an artificial menopause. Menstrua- tion ceases and sterility ensues. Because the normal control that estrogens have on the adrenal cortex is removed, androgens become produced in greater quantities. The frequent result is a face growth suggestive of that of the young male.

3) Medicinal Changes

Because of the subtlety of the endocrine balance, the taking of any hormonal medication may possibly lead to an abnormal growth of hair. Scarcely a drug of this kind is manufactured without a warning on the label that hirsutism may ensue. Cortisone, for example, is a common cause of the problem (Cushing’s syndrome). Birth control pills also have had extraordinary effects on certain women. Some women, for example, who have tended to have excess lanugo hair lose it after using birth control drugs for a short time. Other women who had no problem suddenly blossom forth after using birth control pills. Because each person has her own unique chemistry there is no way to predict her reaction to such drugs. Ordinarily a hair condition will spontaneously return to normal when one ceases taking medication, if the growth has not been stimulated to the terminal-hair stage.

4) Emotional Changes

One last abnormal systemic cause of excess hair must be mentioned, if only to make this outline of causes complete. It has been found that people under stress often develop heavier growths of hair than they would under normal conditions. Women in concentration camps during World War II manifested unusual hirsutism as the result of emotional crisis. This arises from the fact that the adrenal glands are highly active during crisis, to produce large amount of adrenalin. The heightened activity of the adrenal glands results in unusual quantities of hair-causing cortical androgens. Abnormal adrenal activity over a sustained period of time would thus lead to an excess of hair in the target areas. This is not, however, a problem that confronts the electrologist very often.

Summary

We have seen that unwanted hair can be caused in many ways, generally classifiable as congenital, topical, or systemic. Systemic changes are, by far, the most frequent reason for visits to the electrologist. For this ason, if for no other, you should become well acquainted with the symptoms of chronic glandular disorder.

Ask the patron who shows signs of glandular imbalance whether she has been taking hormone preparations of some kind and whether her system is functioning properly. If her answers to these questions indicate serious disorder, suggest that she discuss it with her own doctor. You must be satisfied that the causes of a hair problem are under proper care if you expect to rectify the effects.